'Alright my lovely': The use of terms of endearment as a mitigation device in the care of people living with dementia in the acute hospital environment.

This paper examines how terms of endearment (ToE) are used as a mitigation device in interactions between staff and people living with dementia (PLWD) in the acute hospital environment. ToE are often discouraged in training for healthcare staff. However, this research demonstrates that they are still commonly used in practice. Using conversation analysis, video and audio data were examined to identify the interactional functions of ToE. Analysis showed that ToE play an important role in mitigating potentially face-threatening actions such as when patients are asked to repeat hard-to-interpret talk, or when patient agency is compromised through instruction sequences or having necessary healthcare tasks undertaken. The success of this mitigation is sensitive to the specific interactional circumstances, as well as the responsiveness of the HCP to the patient's voiced concerns. These findings have implications for healthcare practice, training and wider care of PLWD.

A clinical assessment of three-dimensional-printed liver model navigation for thrice or more repeated hepatectomy based on a conversation analysis.

PURPOSES: We performed a conversation analysis of the speech conducted among the surgical team during three-dimensional (3D)-printed liver model navigation for thrice or more repeated hepatectomy (TMRH). METHODS: Seventeen patients underwent 3D-printed liver navigation surgery for TMRH. After transcription of the utterances recorded during surgery, the transcribed utterances were coded by the utterer, utterance object, utterance content, sensor, and surgical process during conversation. We then analyzed the utterances and clarified the association between the surgical process and conversation through the intraoperative reference of the 3D-printed liver. RESULTS: In total, 130 conversations including 1648 segments were recorded. Utterance coding showed that the operator/assistant, 3D-printed liver/real liver, fact check (F)/plan check (Pc), visual check/tactile check, and confirmation of planned resection or preservation target (T)/confirmation of planned or ongoing resection line (L) accounted for 791/857, 885/763, 1148/500, 1208/440, and 1304/344 segments, respectively. The utterance's proportions of assistants, F, F of T on 3D-printed liver, F of T on real liver, and Pc of L on 3D-printed liver were significantly higher during non-expert surgeries than during expert surgeries. Confirming the surgical process with both 3D-printed liver and real liver and performing planning using a 3D-printed liver facilitates the safe implementation of TMRH, regardless of the surgeon's experience. CONCLUSIONS: The present study, using a unique conversation analysis, provided the first evidence for the clinical value of 3D-printed liver for TMRH for anatomical guidance of non-expert surgeons.

Resisting wh-questions in business coaching.

Introduction: This study investigates clients' resisting practices when reacting to business coaches' wh-questions. Neither the sequential organization of questions nor client resistance to questions have yet been (thoroughly) investigated for this helping professional format. Client resistance is understood as a sequentially structured, locally emerging practice that may be accomplished in more passive or active forms, that in some way withdraw from, oppose, withstand or circumvent various interactional constraints (e.g., topical, epistemic, deontic, affective) set up by the coach's question. Procedure and methods: Drawing on a corpus of systemic, solution-oriented business coaching processes and applying Conversation Analysis (CA), the following research questions are addressed: How do clients display resistance to answering coaches' wh-questions? How might these resistive actions be positioned along a passive/active, implicit/explicit or withdrawing/opposing continuum? Are certain linguistic/interactional features commonly used to accomplish resistance?. Results and discussion: The analysis of four dyadic coaching processes with a total of eleven sessions found various forms of client resistance on the active-passive continuum, though the more explicit, active, and agentive forms are at the center of our analysis. According to the existing resistance 'action terminology' (moving away vs. moving against), moving against or 'opposing' included 'refusing to answer', 'complaining' and 'disagreeing with the question's agenda and presuppositions'. However, alongside this, the analysis evinced clients' refocusing practices to actively (and sometimes productively) transform or deviate the course of action; a category which we have termed moving around.

The subjective and objective side of helplessness: Navigating between reassurance and risk management when people seek help for suicidal others.

Social psychologists interested in interaction have demonstrated that help-seeking is a fruitful area for understanding how people relate to one another, but there is insufficient knowledge on how people navigate emotional involvement in help activities. Drawing on discursive psychology and conversation analysis, this article examines third-party calls to a crisis helpline, with emergency calls as a point of comparison, to see how participants manage emotional involvement related to callers' concerns for others. The analysis unpacks how participants orient to helplessness-callers' uncertainty and inability to move forward-as justifying a focus on the at-risk person or on the caller's emotions. While dispatchers at emergency centres work to get pertinent information to send help, call-takers at the crisis helpline are trained to offer emotional support. In the latter case, a caller's displays of helplessness may be treated as a sign of danger for the person at-risk, but it can also be taken as a disposition to worry, warranting a focus on the caller's emotional state. Showing how participants manage this challenge as they navigate 'whom to help', the paper contributes to research on the accomplishment of subjectivity and objectivity and demonstrates the utility of this framework in suicide prevention.

When patients demur: Resisting diagnostic closure in US primary care.

Patients are more engaged in their healthcare than ever before, including in the process of diagnostic sensemaking. But in acute primary care encounters, the interactional flow of the visit is shaped by an orientation toward the physician as the authority over diagnostic reasoning. Once physicians close diagnostic inquiry and transition into counseling, their assessment - and the extent to which it converges with the patient's perspective - comes into full view. Yet this is precisely when patients have reduced occasions to speak up if they do have concerns, as the "train has left the station" both diagnostically and interactionally. Using conversation analysis and a dataset of 75 video recordings of acute primary care encounters in the US, this article examines how patients speak up in this constrained environment. The concept of diagnosis demurral is proposed to describe how patients resist diagnostic closure by renewing the relevance of diagnostic inquiry, either in response to a diagnosis or at any point following the transition into counseling. Findings suggest that patients demur more frequently than prior studies on diagnosis resistance may have predicted, but they do so in ways that maintain deference to the physician's authority over matters of diagnosis: speaking up primarily outside the diagnostic moment, relying on actions in their own domain of expertise (e.g., their illness experience), and working to additionally soften the epistemic and interactional inappositeness of their demurral. This behavior sits at the nexus of two opposing forces: patients may be more engaged, but their participation is constrained by a continued legacy of medical authority over diagnosis, to which patients themselves continue to respond and reproduce.

Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain.

OBJECTIVES: Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP. METHODS: Conversation analyses of physician-patient-encounters and graphical expression of AP-based pain were performed. RESULTS: Twenty-two interactions were recorded and analyzed. Fifteen children were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life. CONCLUSION: Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.

Using Conversation Analysis to explore assessments of decision-making capacity in a hospital setting.

BACKGROUND: Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision-making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best-practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision-making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties. AIMS: This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real-life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)-related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment. METHODS & PROCEDURES: Four naturally occurring capacity assessments were video-recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision-making capacity. The analysis was informed by our knowledge of the MCA best practice guidance. OUTCOMES & RESULTS: An overall structure of capacity assessment that enacted some of the best-practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option-listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub-components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented. CONCLUSIONS & IMPLICATIONS: CA is a feasible empirical method for exploring the structure and conduct of capacity assessments. CA identifies and provides ways of describing interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies including a wider range of health and social care professionals and patients have the potential to inform evidence based training for HCPs who conduct assessments of decision-making capacity. WHAT THIS PAPER ADDS: What is already known on this subject The Mental Capacity Act (MCA) is poorly implemented in practice. Healthcare professionals (HCPs) find it challenging to assess the decision-making capacity of individuals with communication difficulties, and people with communication difficulties are often excluded from or insufficiently supported during capacity assessment. Research is limited to self-report methods. Observational studies of capacity assessment are required. What this study adds This is the first study to use Conversation Analysis (CA) to explore how capacity assessments are conducted in a hospital setting by HCPs with people with communication difficulties as a result of acquired brain injury. One video-recorded capacity assessment was structured in six phases that aligned with best practice MCA guidance. However, other capacity assessments deviated from this structure. One phase, option listing, varied in practice and options were not always presented. What are the clinical implications of this work? CA revealed interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies are warranted to inform training for health and social care professionals who conduct capacity assessments.

Video analysis of communication by physiotherapists and patients in video consultations: a qualitative study using conversation analysis.

OBJECTIVES: To investigate the challenges of doing physical examinations and exercises by video, and the communication strategies used by physiotherapists and patients to overcome them. DESIGN: A qualitative study of talk and social actions, examining the verbal and non-verbal communication practices used by patients and physiotherapists. Video consultations between physiotherapists and patients were video recorded using MS Teams, transcribed and analysed in detail using Conversation Analysis. SETTING: Video consultations were recorded in three specialist settings (long-term pain, orthopaedics, and neuromuscular rehabilitation) across two NHS hospitals. PARTICIPANTS: 15 adult patients (10 female, 5 male; aged 20-77) with a scheduled video consultation. RESULTS: Examinations and exercises retain-->were successfully accomplished in all 15 consultations. Two key challenges were identified for physiotherapists and patients when doing video assessments: (1) managing safety and clinical risk, and (2) making exercises and movements visible. Challenges were addressed by through communication practices that were patient-centred and tailored to the video context (e.g., explaining how to frame the body to the camera or adjust the camera to make the body visible). CONCLUSIONS: Video is being used by physiotherapists to consult with their patients. This can work well, but tailored communication strategies are critical to help participants overcome the challenges of remote physical examinations and exercises. CONTRIBUTION OF THE PAPER: This paper is a first to use video-based analysis to determine the challenges of video consulting for doing remote assessments and exercises in physiotherapy settings. It demonstrates how patients and physiotherapists use communication strategies to raise concerns around safety and visibility and how they overcome these concerns.

Metaphoric language in the differential diagnosis of epilepsy and psychogenic non-epileptic seizures: Time to move forward.

Conversation analysis (CA) to identify metaphoric language (ML) has been proposed as a tool for the differential diagnosis of epileptic (ES) and psychogenic nonepileptic seizures (PNES). However, the clinical relevance of metaphoric conceptualizations is not clearly defined. The current study aims to investigate the ML utilized by individuals with ES and PNES in a pulled multi-country sample. Two blinded researchers examined the transcripts and videos of 54 interviews of individuals (n = 29, Italy; n = 11, USA; n = 14, Russia) with ES and PNES, identifying the patient-seizure relationship representative of the patient's internal experience. The diagnoses were based on video-EEG. Metaphors were classified as "Space/place", "External force", "Voluntary action", and "Other". A total of 175 metaphors were identified. No differences between individuals with ES and PNES were found in metaphoric occurrence (χ2 (1, N = 54) = 0.07; p = 0.74). No differences were identified when comparing the types of metaphors utilized by participants with ES and those with PNES. Patients with PNES and ES did not demonstrate differences in terms of occurrence and categories in ML. Therefore, researchers and clinicians should carefully consider the use of metaphor conceptualizations for diagnostic purposes.

Why affiliation matters: A conversation analysis of complaints calls to the NHS.

OBJECTIVE: Callers making a complaint share their negative experience in complaint narratives that make relevant affiliation from an operator. We examined how call handlers' language choices affect both the progress of the call and the stance of the caller. METHODS: We identified episodes where affiliation is displayed or noticeably absent in a dataset of 95 complaints calls to the NHS. Two single cases were closely examined using conversation analysis. RESULTS: Affiliation at sequentially relevant moments in conversation helps progress the call and de-escalate the complaint while the absence or misplacement of affiliation may lead to escalation. The latter recurringly involves blaming whilst de-escalation includes practices that diffuse blame. Early intervention in the form of affiliation to the 'hurt' component and the reasoning of the complaint is essential to de-escalation. CONCLUSION: Our analysis revealed three key functions of affiliation in complaints calls: 1) ratifying the reasonableness of the complaint; 2) progressing the institutional requirements of the call; 3) de-escalating the complaint. PRACTICE IMPLICATIONS: Call handlers should listen for callers' cues for legitimization of the complainability of their concerns and seek to provide responses that express affiliation.

Questions to promote child-centered care in racially discordant interactions in pediatric oncology.

OBJECTIVE: To examine questioning practices in racially discordant interactions and describe how these practices engendered child-centered care. METHODS: We used applied conversation analysis to analyze a collection of 300 questions directed to children across 10 cases involving children of color and their families in disease reevaluation appointments in pediatric oncology. RESULTS: Our analysis generated two patterns: 1) both the pediatric oncologists' and caregivers built upon one another's talk to enable the child's conversational turn, and 2) the oncologists' reformulated requests as questions to invite the child's permission and cooperation for completing exams and understanding symptoms. CONCLUSION: Children, pediatric oncologists, and caregivers coordinated their actions to enable children to participate as recipients of and respondents to questions. The analysis of real-time interactions illuminates practices for centering children in clinical encounters and the benefits of doing so. PRACTICAL IMPLICATIONS: This study's findings have implications for defining competencies and practices for fostering child-centered communication, creating training materials based on real-time encounters, and identifying strategies for humanizing pediatric patient experiences.

Investigating question-answer sequences in child mental health assessments: Engaging children and families through declarative question design.

OBJECTIVE: In mental health settings, before a child can be diagnosed with a mental health condition, they must initially be assessed. These assessments are characterised by question-answer sequences with the child and family members, and our objective is to explore the function of declarative questions. METHODS: Video recordings of mental health assessments from 28 families were collected, each being approximately 90 min. Referred children were aged 6-17-years. Data were transcribed using the Jefferson approach and conversation analysis was used. RESULTS: Attention to question-answer sequences identified that one common type was the declarative question. We focus on three identifiable forms: clean language short declaratives, declaratives with extreme case formulations, and reformulation declaratives. CONCLUSIONS: The response to these three types of declaratives formed the basis for subsequent question-answer elaboration sequences. The question functioned both to engage the child directly and align with other family members. PRACTICE IMPLICATIONS: Implications for practitioners are that these types of declarative questions offer a resource to engage in fact-checking in a way that is non-face-threatening. Conversation analysis provides a methodological tool for practitioners to engage in reflective practice to enhance their clinical skills in relation to question design.

Responsibility to report symptoms: Pursuing symptom reports from children in pediatric encounters.

OBJECTIVE: The paper focuses on cases in which children disconfirm a symptom previously reported by their parents and analyzes how doctors and parents continue asking questions to elicit symptom confirmation from children. METHODS: The study employs Conversation Analysis (CA) to examine 50 video recordings of Russian-language pediatric consultations with 4 pediatricians and approximately 50 children. RESULTS: The findings indicate two strategies used by participants to pursue symptom confirmation. First, calibrating question design via changing the questions' format and narrowing the questions' topical agenda to specify what kind of information is expected from the child. Second, changing the questions' format (from content to polar) without adjusting the topical agenda. CONCLUSION: The paper argues that engaging children in medical consultations might be challenging because they do not orient to, and so do not perform a responsibility that is institutionally expected from patients, in particular, reporting medically-relevant information. PRACTICE IMPLICATIONS: The analysis shows that using polar questions about everyday activities and experiences relevant to the child and pursuing symptom reports by gradually narrowing down the questions' topical agenda can be an effective way to secure medically-relevant information.

Questions directed to children with diverse communicative competencies in paediatric healthcare consultations.

OBJECTIVE: This paper examines question-response sequences, in which clinicians asked questions to child patients who appear to interact using means other than the verbal mode of communication. METHODS: Conversation Analysis methods were used to study questions in 46 paediatric palliative care consultations. These questions were directed towards children who observably used vocalisations and embodied modes of communication (e.g., gaze, gesture and facial expressions) but did not appear to use the verbal mode. RESULTS: Most questions asked children either about their willingness and preferences for a proposed next activity, or their current feelings, experiences or intentions. Questions involved children by foregrounding their preferences and feelings. These questions occasioned contexts where the child's vocal or embodied conduct could be treated as a relevant response. CONCLUSION: This paper demonstrates how questions are used to involve children in consultations about their own healthcare, and how their views come to be understood by clinicians and family members, even when children interact using means other than the verbal mode of communication. PRACTICE IMPLICATIONS: Questions can be asked of both children who do and do not verbally communicate. When asking questions, clinicians should be mindful of the modes of communication an individual child uses to consider how the child might meaningfully respond.

"Are you otherwise fit and well?": Past medical history questions in UK paediatric consultations.

Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. OBJECTIVE: To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations. METHODS: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory. RESULTS: Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing. CONCLUSION: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. PRACTICE IMPLICATIONS: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.

Speaking partners' talk in transitions between symbols in conversations that use speech-output technologies.

Aided conversations differ from spoken ones in their transitions between turns and symbols because seeking and choosing symbols takes more time than speaking words naturally. This study adopted the concepts and principles of conversation analysis (CA) to analyze the transitions between symbols during the construction of aided turns. The data was from the spontaneous conversations at home between mothers and four males (sons) who used speech-output technologies. The analyses compared the durations of transitions between turns and symbols and frequency of mothers' talk during the transitions. The mothers most often remained silent during the symbol-transitions, but when they talked, their speech was inspired by the current context and was not coincidental. When the mothers spoke during the symbol-transitions, their sons either continued or paused constructing their turn. Despite the effect on the progress of conversations, the participants did not orient to these expanded aided turns as challenging. The expansions manifested (a) in parallel (b) side by side with the aided turn, and (c) as a part of the ongoing aided turn. Analyzing the structural characteristics of aided conversations deepens our understanding of theoretical concepts, offers strategies to guide aided communicators and their partners, and helps to develop augmentative and alternative communication technologies that promote interactive communication.

Claiming or abdicating medical authority: Treatment recommendation actions, doctor-patient relationship, and antibiotic overprescription in Chinese paediatrics.

Antibiotic overprescription in China has long been considered a problem on the supply side, linked to the financial incentives of physicians. Based on the conversation analysis of 187 video-recorded naturally occurring medical consultations in Chinese paediatric primary care settings, this study finds that the driving force behind the problem of antibiotic overprescription in China has changed. Physicians use a low-authority communication style to recommend treatment, displaying a low level of medical authority and a willingness to accommodate caregivers' preferences in antibiotic prescribing decisions. The problem is now attributed to physician-caregiver interaction, doctor-patient relationship and the antibiotic-saturated prescribing culture. Practice implications involve deepening the understanding of the evolving nature of the antibiotic overprescription problem in China, building trust between physicians and patients/caregivers in order to facilitate the physicians' role as the gatekeeper of antibiotics and providing training programmes to help physicians develop effective communication skills.

Being right vs. getting it right: orientation to being recorded in psychotherapeutic interaction as disaffiliative vs. affiliative practice.

Introduction: The study focuses on the orientation to being recorded in therapy sessions, emphasizing that these practices adapt to specific circumstances and influence subsequent actions. The study suggests a way to deal with the insolubility of the "observer paradox": to accept that observation has an impact on the observed, but that the recorder is not necessarily a negative determinant. Furthermore, the study builds on the idea that participants' orientations to the recorder can be seen as actions. Methods: The data included in this study were collected from four psychodynamic therapies. A total of 472 sessions were searched for orientation to be recorded. Twenty-three passages were found and transcribed according to GAT2. Of the 23 transcripts, six excerpts have been analyzed as part of this article. The analysis of this study was done through Conversation Analysis. Results: The study explores how participants use the orientation to be recorded to initiate or alter actions within conversations, which can help achieve therapeutic goals, but can also hinder the emergence of a shared attentional space as the potential to disrupt the therapist-patient relationship. The study identifies both affiliative and disaffiliative practices, noting that managing orientation to be recorded in a retrospective design consistently leads to disruptive effects. Moreover, it highlights the difference between seeking epistemic authority ("being right") and managing recording situations ("getting it right") in therapeutic interactions as a means of initiating patients' self-exploration. Discussion: The integration of recordings into therapeutic studies faces challenges, but it's important to acknowledge positive and negative effects. Participants' awareness of recording technologies prompts the need for a theory of observation in therapeutic interactions that allows therapists to visualize intuitive practices, incorporate active contributions, counteract interpretive filtering effects, facilitate expert exchange, ensure quality assurance, and enhance the comprehensibility of therapeutic processes. These aspects outline significant variables that provide a starting point for therapists using recordings in therapeutic interactions.

Spectrum of complaints: practices of complaining in therapeutic conversations as a window to spouses' personalities and couples' relationships.

Introduction: Complaining is a frequent phenomenon in human interactions and it frequently happens during couple counseling. A conversation between a therapist and spouses that requires them to talk about problems inevitably leads to complaining (especially during the first meeting). The institutional context and the presence of an impartial therapist shape the complaining sequences. Method: We used conversation analysis to explore the interactional organization of complaining in the specific context, which is couples therapy. Our data involve video recordings of nine couple therapy first consultations. Results: In the results section of our paper, we describe in detail the composition and delivery of complaints in couple therapy setting. Our observations made it possible to propose a nuanced spectrum of ways of complaining that spans the considerateness dimension. Our data suggest that there may be a relationship between the manner of complaining and the presence and severity of maladaptive personality traits of complainers. Discussion: We argue that paying close attention to complaining practices that arise during couple therapy is an important aspect of clinical work with couples and can be informative regarding the nature of spouses' quarrels and their personality constitutions.

The emergence of social order in everyday interacting: re-conceptualizing a venerable sociological concept in light of conversation analysis.

For more than a century social theorists have asked how order at the macro-social level is related to human activity at the micro-social level. Among their answers are accounts of macro-level social order as emerging in micro-level relations among individuals. Sawyer's account of macro-level emergence in micro-level interaction rests on the individual's understandings of interactional frames. However, Rawls draws on Garfinkel and Sacks to argue that sociologist's accounts of the macro-level interaction order need to be grounded in observable, micro-level social practices, instead of using conceptual abstractions like frames. Arundale's Conjoint Co-constituting Model of Communicating is grounded in research on observable social practices in Conversation Analysis, and offers an account of the emergence, in particular episodes of everyday interacting, of properties that define micro-level social systems. That account provides the basis for an account of the emergence, in recurrent micro-level interacting over time and space, of properties that define macro-level social systems. The basic idea is not new: what is new is accounting for the emergence of macro-level social order in terms of the recurrent emergence of micro-level social order as participants engage observable social practices in everyday interacting. Re-conceptualizing the emergence of macro-social order addresses sociology's longstanding puzzlement regarding the macro-micro link, and points to needed research.